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Achilles Tendon Rupture: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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4

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Get the facts

Your options

Key points to remember

You can treat an Achilles tendon rupture with
surgery or by using a cast, splint, brace, walking
boot, or other device that will keep your lower leg and ankle from moving (immobilization).

Both surgery and immobilization are usually successful. Another
rupture is less likely after surgery than after immobilization. But
immobilization has fewer other risks.

The success of your surgery depends
on many things, including how badly your tendon is damaged, how soon after your
rupture you have surgery, and how soon you start and how well you follow a rehabilitation program.

If you are younger or are physically active in sports, at
work, or at home, surgery is often advised. If you are older or are inactive,
immobilization is often advised.

The
Achilles tendon connects the calf muscles to the heel bone. It is the biggest
tendon in the human body, and it allows you to rise up on your toes while
walking. It withstands a large amount of force with each foot movement.

An Achilles tendon rupture occurs when the tendon is
completely torn in two. When this happens, your leg may be weak, and walking
may be difficult. You may not be able to rise up on your toes.

Surgery is the most
common treatment for Achilles tendon rupture. It reattaches the torn ends of
the tendon. It can be done with one large incision (open surgery) or many
smaller incisions (percutaneous surgery).

Nonsurgical treatment
starts with immobilizing your leg. This prevents you from moving the lower leg
and ankle so that the ends of the Achilles tendon can reattach and heal. A
cast, splint, brace, walking boot, or other device may be used to do this.

Both
immobilization and
surgery are often successful. They both help the
tendon to heal. Another rupture is less likely after surgery than after
immobilization, but immobilization has fewer other risks.

The risks of
surgery are similar, whether you have percutaneous surgery or open surgery. The
biggest risk of either type of surgery is wound infection. It is more common with open surgery. Your risk can also
change depending on whether you begin walking and using your foot sooner after
surgery rather than later. This is called early mobilization.

The small risk of other complications was about the same with either open or percutaneous surgery, and most problems go away over time. These complications included pain, delayed wound healing, nerve damage, and problems with scarring.

With
immobilization, the greatest risk is that the tendon will rupture again.

As with surgery, minor pain and
temporary nerve damage are also risks when immobilization with a cast or brace
is used. There is also a very slight risk of
deep vein thrombosis or permanent nerve damage with
nonsurgical treatment.

Effects on pain and activity

When it comes to reducing problems with pain, wearing shoes, and walking, surgery may help more than treatment with a cast or brace. (The quality of the evidence about this is inconclusive.)

Out of 100 people who have surgery, 73 of them will not have any problems 1 year later. This means that 27 out of 100 will still have problems.

Out of 100 people who don't have surgery, 51 of them will not have any problems 1 year later. This means that 49 out of 100 will still have problems.

When it comes to helping people return to sports at the level they were before they got hurt, the results are about the same with or without surgery. (The quality of the evidence about this is borderline.)

Out of 100 people who have surgery, 69 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 31 out of 100 will not.

Out of 100 people who don't have surgery, 68 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 32 out of 100 will not.

Risk of tendon rupturing again

No matter what kind of treatment you have, there is a chance that your Achilles tendon will rupture again. Evidence suggests that this may be less likely with surgery. (The quality of the evidence about this is borderline.)

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is-the higher its quality-the more we can trust it.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

Compare your options

Have surgery for
Achilles tendon rupture Have surgery for
Achilles tendon rupture

You will most likely go home the
same day as surgery.

You will spend 6 to 12 weeks after surgery
wearing a walking cast or boot.

If you sit at work, you can go back in 1 to 2 weeks. If you're on
your feet at work, you may need 6 to 8 weeks before you can go back.

Your total recovery time can be up to 6 months.

Surgery repairs the tendon and
makes another rupture less likely.

You can go back to work and
resume daily activities sooner than with immobilization.

All surgery has risks, including bleeding and infection. Your age
and your health can also increase your risk.

You may have:

Minor pain and temporary nerve
damage.

Slight risk of deep vein thrombosis or permanent nerve
damage.

A small risk of repeat tendon rupture.

Treat the rupture with a
cast or brace (immobilization) Treat the rupture with a
cast or brace (immobilization)

You'll wear a cast, splint,
brace, walking boot, or other device for several months.

Your total recovery time can be up to 6 months.

Immobilization allows you to
avoid surgery and the risk of wound infection.

You may have:

Repeat tendon rupture.

Loss of
strength in the leg.

Minor pain and temporary nerve damage.

A very
slight risk of deep vein thrombosis or permanent nerve damage.

Personal stories about surgery for Achilles tendon rupture

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I blew out
my Achilles playing basketball-and we still lost! I've talked to my doctor
about this, and he recommends surgery, as I want to continue playing basketball
and am active in a lot of other ways. I'm going with an open surgery, because
that seems to be the best for not having another rupture. I realize there is
more of a possibility for wound infection, but that's worth the risk-I don't
want to pop my Achilles again, and, to tell the truth, I don't really worry
about infections.

Carlo, age 34

I don't
really know how I did it, but I ruptured my Achilles tendon. I guess sometimes
a simple action can do it. I don't like the idea of surgery, so I'm going with
a cast and a good rehab program. Although I like to go for walks, I'm not an
athlete by any means, so my doctor says I probably shouldn't have to worry
about doing it again.

Marian, age 55

And I thought my injury days were over! I
gave up playing sports a while back, but I still referee young children's
soccer games. At the last one I did, whack, there went my Achilles. Now I have
to decide what to do. I'm not overly active, but I still like to get around.
I'm also getting to the point where surgery and potential complications bother
me, but on the other hand, I really don't want another rupture. My doctor told
me he knows a surgeon who is very experienced in a type of surgery that does
not make a big cut-I believe it's called percutaneous surgery. This surgery is
supposed to solidly fix the tendon but have less risk of complications. This
sounds good to me, especially because the surgeon is experienced.

Brandi, age
45

I started jogging again after quite a few
years, and a week later, blam!-out goes my Achilles. Talk about bad luck! My doc
says surgery would be no problem, as I'm a young guy in good health. But
surgery just bugs me. I'd rather have a cast, even if my doc says an operation
gives me less risk of doing it again. But I've learned my lesson. After the
cast comes off, I'll pay more attention to warming up and starting slowly with new activities. I won't
be one of those guys who reruptures after using a cast!

Fred, age 33

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose surgery for a ruptured Achilles tendon

Reasons to choose a cast or brace (immobilization) to treat a ruptured Achilles tendon

I don't want to risk having another tendon rupture.

I'm willing to take the risk of having another tendon rupture if it means not having surgery.

More important

Equally important

More important

My job requires that I have strong legs.

My job doesn't require that I have strong legs.

More important

Equally important

More important

I'm not worried about the risks of surgery.

I'm worried about the risks of surgery.

More important

Equally important

More important

I'm an active person, and I want to stay active.

I am not very active in my daily life, and being active is not that important to me.

More important

Equally important

More important

I want to return to my normal activity levels as soon as possible.

The long recovery time does not bother me.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Immobilization (no surgery)

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, I am less likely to rupture the tendon again if I have surgery than if I use a cast or brace.

TrueYou're right. You are less likely to have another rupture after surgery than after treatment with a cast or brace.

FalseSorry, that's not right. You are less likely to have another rupture after surgery than after treatment with a cast or brace.

I'm not sureIt might help to go back and read "Get the Facts." You are less likely to have another rupture after surgery than after treatment with a cast or brace.

2.2, Surgery has some risks that immobilization does not.

TrueYou are right. Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as a deep wound infection.

FalseSorry, that's not right. Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as deep wound infection.

I'm not sureIt may help to go back and read "Get the Facts." Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as deep wound infection.

3.3, My job requires a lot of walking. Immobilization gives me the best chance of getting back to that without problems.

TrueSorry, that's not right. People who have surgery are less likely to have problems with walking than people who use immobilization.

FalseYou are right. People who have surgery are less likely to have problems with walking than people who use immobilization.

I'm not sureIt may help to go back and read "Get the Facts." People who have surgery are less likely to have problems with walking than people who use immobilization.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Achilles Tendon Rupture: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery for a ruptured Achilles tendon.

Treat
the rupture with a cast or brace (immobilization).

Key points to remember

You can treat an Achilles tendon rupture with
surgery or by using a cast, splint, brace, walking
boot, or other device that will keep your lower leg and ankle from moving (immobilization).

Both surgery and immobilization are usually successful. Another
rupture is less likely after surgery than after immobilization. But
immobilization has fewer other risks.

The success of your surgery depends
on many things, including how badly your tendon is damaged, how soon after your
rupture you have surgery, and how soon you start and how well you follow a rehabilitation program.

If you are younger or are physically active in sports, at
work, or at home, surgery is often advised. If you are older or are inactive,
immobilization is often advised.

FAQs

What is the Achilles tendon, and what is an Achilles tendon rupture?

The
Achilles tendon connects the calf muscles to the heel bone. It is the biggest
tendon in the human body, and it allows you to rise up on your toes while
walking. It withstands a large amount of force with each foot movement.

An Achilles tendon rupture occurs when the tendon is
completely torn in two. When this happens, your leg may be weak, and walking
may be difficult. You may not be able to rise up on your toes.

How well do treatments work?

Surgery is the most
common treatment for Achilles tendon rupture. It reattaches the torn ends of
the tendon. It can be done with one large incision (open surgery) or many
smaller incisions (percutaneous surgery).

Nonsurgical treatment
starts with immobilizing your leg. This prevents you from moving the lower leg
and ankle so that the ends of the Achilles tendon can reattach and heal. A
cast, splint, brace, walking boot, or other device may be used to do this.

Both
immobilization and
surgery are often successful. They both help the
tendon to heal. Another rupture is less likely after surgery than after
immobilization, but immobilization has fewer other risks.

The success of your surgery depends on:

Your surgeon's experience.

The
type of surgery you have (percutaneous or open surgery).

How badly
your tendon is damaged.

How soon after the rupture your surgery is
done.

How soon your
rehabilitation (rehab) program starts after
surgery.

How well you follow your rehab program.

What are the risks of surgery?

The risks of
surgery are similar, whether you have percutaneous surgery or open surgery. The
biggest risk of either type of surgery is wound infection. It is more common with open surgery. Your risk can also
change depending on whether you begin walking and using your foot sooner after
surgery rather than later. This is called early mobilization.

The small risk of other complications was about the same with either open or percutaneous surgery, and most problems go away over time. These complications included pain, delayed wound healing, nerve damage, and problems with scarring.

What are the risks of immobilization?

With
immobilization, the greatest risk is that the tendon will rupture again.

As with surgery, minor pain and
temporary nerve damage are also risks when immobilization with a cast or brace
is used. There is also a very slight risk of
deep vein thrombosis or permanent nerve damage with
nonsurgical treatment.

What do numbers tell us about treatment for a ruptured Achilles tendon?

Effects on pain and activity

When it comes to reducing problems with pain, wearing shoes, and walking, surgery may help more than treatment with a cast or brace. (The quality of the evidence about this is inconclusive.)

Out of 100 people who have surgery, 73 of them will not have any problems 1 year later. This means that 27 out of 100 will still have problems.

Out of 100 people who don't have surgery, 51 of them will not have any problems 1 year later. This means that 49 out of 100 will still have problems.

When it comes to helping people return to sports at the level they were before they got hurt, the results are about the same with or without surgery. (The quality of the evidence about this is borderline.)

Out of 100 people who have surgery, 69 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 31 out of 100 will not.

Out of 100 people who don't have surgery, 68 of them will be back at their regular level of sports activity within 1 to 2 years. This means that 32 out of 100 will not.

Risk of tendon rupturing again

No matter what kind of treatment you have, there is a chance that your Achilles tendon will rupture again. Evidence suggests that this may be less likely with surgery. (The quality of the evidence about this is borderline.)

Understanding the evidence

Some evidence is better than other evidence. Evidence comes from studies that look at how well treatments and tests work and how safe they are. For many reasons, some studies are more reliable than others. The better the evidence is-the higher its quality-the more we can trust it.

Another thing to understand is that the evidence can't predict what's going to happen in your case. When evidence tells us that 2 out of 100 people who have a certain test or treatment may have a certain result and that 98 out of 100 may not, there's no way to know if you will be one of the 2 or one of the 98.

2. Compare your options

You will spend 6 to 12 weeks after surgery
wearing a walking cast or boot.

If you sit at work, you can go back in 1 to 2 weeks. If you're on
your feet at work, you may need 6 to 8 weeks before you can go back.

Your total recovery time can be up to 6 months.

You'll wear a cast, splint,
brace, walking boot, or other device for several months.

Your total recovery time can be up to 6 months.

What are the benefits?

Surgery repairs the tendon and
makes another rupture less likely.

You can go back to work and
resume daily activities sooner than with immobilization.

Immobilization allows you to
avoid surgery and the risk of wound infection.

What are the risks and side effects?

All surgery has risks, including bleeding and infection. Your age
and your health can also increase your risk.

You may have:

Minor pain and temporary nerve
damage.

Slight risk of deep vein thrombosis or permanent nerve
damage.

A small risk of repeat tendon rupture.

You may have:

Repeat tendon rupture.

Loss of
strength in the leg.

Minor pain and temporary nerve damage.

A very
slight risk of deep vein thrombosis or permanent nerve damage.

Personal stories

Personal stories about surgery for Achilles tendon rupture

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I blew out my Achilles playing basketball-and we still lost! I've talked to my doctor about this, and he recommends surgery, as I want to continue playing basketball and am active in a lot of other ways. I'm going with an open surgery, because that seems to be the best for not having another rupture. I realize there is more of a possibility for wound infection, but that's worth the risk-I don't want to pop my Achilles again, and, to tell the truth, I don't really worry about infections."

— Carlo, age 34

"I don't really know how I did it, but I ruptured my Achilles tendon. I guess sometimes a simple action can do it. I don't like the idea of surgery, so I'm going with a cast and a good rehab program. Although I like to go for walks, I'm not an athlete by any means, so my doctor says I probably shouldn't have to worry about doing it again."

— Marian, age 55

"And I thought my injury days were over! I gave up playing sports a while back, but I still referee young children's soccer games. At the last one I did, whack, there went my Achilles. Now I have to decide what to do. I'm not overly active, but I still like to get around. I'm also getting to the point where surgery and potential complications bother me, but on the other hand, I really don't want another rupture. My doctor told me he knows a surgeon who is very experienced in a type of surgery that does not make a big cut-I believe it's called percutaneous surgery. This surgery is supposed to solidly fix the tendon but have less risk of complications. This sounds good to me, especially because the surgeon is experienced."

— Brandi, age
45

"I started jogging again after quite a few years, and a week later, blam!-out goes my Achilles. Talk about bad luck! My doc says surgery would be no problem, as I'm a young guy in good health. But surgery just bugs me. I'd rather have a cast, even if my doc says an operation gives me less risk of doing it again. But I've learned my lesson. After the cast comes off, I'll pay more attention to warming up and starting slowly with new activities. I won't be one of those guys who reruptures after using a cast!"

— Fred, age 33

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose surgery for a ruptured Achilles tendon

Reasons to choose a cast or brace (immobilization) to treat a ruptured Achilles tendon

I don't want to risk having another tendon rupture.

I'm willing to take the risk of having another tendon rupture if it means not having surgery.

More important

Equally important

More important

My job requires that I have strong legs.

My job doesn't require that I have strong legs.

More important

Equally important

More important

I'm not worried about the risks of surgery.

I'm worried about the risks of surgery.

More important

Equally important

More important

I'm an active person, and I want to stay active.

I am not very active in my daily life, and being active is not that important to me.

More important

Equally important

More important

I want to return to my normal activity levels as soon as possible.

The long recovery time does not bother me.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Immobilization (no surgery)

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
I am less likely to rupture the tendon again if I have surgery than if I use a cast or brace.

True

False

I'm not sure

You're right. You are less likely to have another rupture after surgery than after treatment with a cast or brace.

2.
Surgery has some risks that immobilization does not.

True

False

I'm not sure

You are right. Like most surgeries, Achilles tendon surgery does have some risks that nonsurgical treatment does not have, such as a deep wound infection.

3.
My job requires a lot of walking. Immobilization gives me the best chance of getting back to that without problems.

True

False

I'm not sure

You are right. People who have surgery are less likely to have problems with walking than people who use immobilization.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

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